Surprise! - Some “less expensive” plans will not pay for a doctor visit before you meet your annual deductible

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JONATHAN M. METSCH, DR.P.H., LLCHudson Reporter

May 06, 2014 | 454 views | 0 | 0 | |

Just when you thought that maybe you sort of understood the cost of an Obamacare health care insurance policy, a Kaiser Health News article http://www.kaiserhealthnews.org/

* noted: "This could be the next shoe to drop, as people don't realize that if they're buying a bronze plan, they may have to pay $5,000 out of pocket before it contributes a penny.."

“Experts worry that some enrollees will be discouraged from seeing doctors if they have to pay the full charge, rather than simply a copayment.

Those who’ve bought their own insurance have always had to pay a set annual sum, called a deductible, before policies begin paying their claims. But first-time insurance buyers may not realize they’re on the hook for additional costs before benefits kick in, and may choose a plan based solely on the monthly premiums.

Bronze plans -- which have lower monthly costs but typically, higher deductibles -- are the most likely to require consumers to spend that amount themselves before the insurer pays any claims.

Silver plans, which generally have higher monthly premiums, are more generous, with more than three-quarters paying for doctor visits before the deductible is met.

Under the law, Congress granted insurers leeway in how they design their plans, so long as bronze plans cover at least 60 percent of the costs of a typical policyholder, silver plans cover 70 percent, gold plans cover 80 percent and platinum plans cover 90 percent – with consumers on the hook for the remainder.”

“Plans that list a price for a doctor visit followed by the phrase "after the deductible is met" mean the consumer must pay the full deductible before getting doctor visits for a small copayment. “

*to read the full KHN article click on Consumers Beware: Not All Health Plans Cover A Doctor's Visit Before The Deductible Is Met Julie Appleby, highlight and click on open hyperlink http://www.kaiserhealthnews.org/Stories/2013/December/23/consumers-with-less-expensive-plans-spend-thousands-before-coverage-begins.aspx